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Herniated discs and spinal stenosis

The National Center for Health Statistics reports that 14% of all new visits to doctors are for low-back pain. About one in four back pain patients has a herniated disc. Spinal stenosis, a narrowing of the spinal column, is another common cause of back pain.

Dr. Foroohar offers a number of non-surgical and surgical treatments to relieve the pain of herniated discs and spinal stenosis. “Only 10 to 15% of patients I evaluate for spine problems need surgery,” she says.

What are discs?

The spine consists of 33 bony vertebrae. Discs—also known as intervertebral discs—are the shock absorbers between the vertebrae. Each disc is made up of:

A tough outer ring called the annulus, and

A soft inner core called the nucleus, filled with a gel-like substance

What is a herniated disc?

A herniated or ruptured disc occurs when the gel-like filling of the nucleus bulges or leaks out through the disc's outer ring. This bulging or leaking disc filling can press on nerves in the neck and spine, causing severe pain.

What can cause a herniated disc?

Several factors can weaken the discs in your spine. Discs, which have high water content in children and young adults, lose some of their water content with age. This makes the discs smaller and less flexible—decreasing the spaces between the spinal vertebrae and increasing the risk of a herniated disc and compression of the nerve.

What are the symptoms of a herniated disc?

Herniated disc symptoms vary, depending on whether the affected disc is in the upper back (cervical spine) or lower back (lumbar spine). “It is not very common to have a herniated disc in the thoracic spine, or middle back, because that section of the spine is anchored and supported by the rib cage,” says Dr. Foroohar.

Although the problem originates in the spine, herniated discs can produce symptoms in the arms or legs when the disc filling irritates nearby nerves. This condition is called radiculopathy.

Symptoms of a herniated disc in the neck or upper back may include:

Neck pain

Arm or shoulder pain

Arm or hand weakness, numbness or tingling

Symptoms of a herniated disc in the lower back may include:

Back pain

Leg pain

Leg or foot weakness, numbness or tingling

Bowel or bladder complaints

What is spinal stenosis?

Spinal stenosis is a narrowing of the spinal canal, leading to painful pinching of the spinal cord and/or nerves in the spine. Degenerative spinal stenosis results from the aging process. Much less commonly, spinal stenosis can be congenital—something you're born with. It can occur anywhere in the spine including neck and upper back (cervical spine), mid-back (thoracic spine) or lower back (lumbar spine).

How do you diagnose a herniated disc or spinal stenosis?

If you are experiencing symptoms of a herniated disc or spinal stenosis, I will examine you and ask about your symptoms to help determine which part of the spinal cord or spinal nerve roots may be causing your symptoms. I will also order imaging studies, which may include an MRI, and sometimes x-rays and or a CT scan, to confirm the diagnosis.

Can a herniated disc ever compress the spinal cord?

Yes. Some patients may have myelopathy—compression of the spinal cord—in addition to radiculopathy. That's the case when the herniated disc isn't just pushing on the nerve, but is also compressing the spinal cord. This compression can occur in the cervical or thoracic spine. The spinal cord ends at the junction of the thoracic and lumbar spine.

Myelopathy is more urgent than radiculopathy because when the spinal cord is pinched, you can have more than just nerve involvement—you can have both arms and both legs involved. These patients can have the symptoms of a herniated disc, plus balance problems and weakness, numbness and tingling in their arms and legs from the spinal cord compression.

Often, a patient who already has degenerative disc disease, a herniated disc or spinal stenosis will get into an accident or suffer an injury. When this happens, the new injuries exacerbate their original problem.

How do you treat a herniated disc or spinal stenosis non-surgically?

Depending on the results of your physical exam, MRIs and other imaging studies, I may recommend:

Oral medication—muscle relaxants and sometimes steroids
or other anti-inflammatory drugs

Physical therapy

Movement and physical restrictions: No lifting, etc.

Then we see how you do. Most patients get better with conservative treatment and don't need surgery. If your pain is caused by a herniated disc or spinal stenosis, recovery could take several months. Muscle pain resolves faster.

Do you refer patients to other specialists for non-surgical treatment?

When do you recommend surgery?

Having neck surgery or lower-back surgery is not just a matter of pain—it's when persistent numbness, tingling or weakness is affecting your quality of life. Many factors play a role in the decision to have surgery; I will give you the information you need to help you decide if and when surgery is right for you.